Q: Can you explain what the Medicare Part A and Part B premiums will be in 2016?
A: For most beneficiaries, the answer is simple: they will be the same in 2016 as they were in 2015. That’s because there will be no Social Security cost-of-living increase in 2016 benefits. As a result, most people will pay the same premium for Part B, as long as the premium is withheld from their Social Security benefit check. That’s about 70% of all people on Medicare. Also, since 99% of beneficiaries get Part A Medicare coverage without a premium (since they or their spouse have at least 40 calendar quarters of Medicare-covered employment during their lives), that won’t change, either.
Q: What about people who don’t qualify for the no increase in 2016 in their Medicare Part B Premiums? How much will they pay?
A: Some beneficiaries will not qualify for the rule that keeps their Part B premium unchanged. These include: people who do not yet collect Social Security benefits; people who will become new beneficiaries in 2016; people who have their Part B premiums paid through a different process, such as Federal retirees; and people who pay an additional premium already, because of their income. People on both Medicare and Medicaid, whose premiums are paid by their States, are also ineligible for unchanged premiums. All beneficiaries in those categories will see an increase in their Part B premiums to $121.80 per month (higher for those with income-related surcharges). These groups together account for about 30% of Medicare’s 52 million beneficiaries.
Q: Are Medicare Part A and B deductibles going up, too? Will some people be exempt from those increases?
A: The Part A deductible for an inpatient hospital admission is going up from $1,260 in 2015 to $1,288 in 2016. Co-insurance for stays beyond 60 days, and for stays in a skilled nursing facility following an inpatient admission will also increase, by a modest 2.2% in 2016.
The Part B deductible is increasing from $147 in 2015 to $166 in 2016. This is the first increase in the Part B deductible in 3 years. These increases will apply to all beneficiaries; those exempt from premium increases will still be subject to the new deductible and co-pay amounts in 2016.
For more information about 2016 premiums and deductibles, you can go to www.medicare.gov, or call Medicare any time of day or night, at 1-800-MEDICARE [1-800-633-4227].
Q: For those consumers who do not have Medicare, or other health insurance, I hear that it is Open Enrollment again through January 31, through the Health Insurance Marketplace; can you tell me about this?
A: Yes, Open Enrollment for 2016 Health Insurance Marketplace coverage at healthcare.gov started November 1, and goes through January 31. If you want coverage to begin January 1, you need to enroll before December 15.
The Health Insurance Marketplace is a way for those without health insurance or those who want to look for a better option to find health care coverage from private health insurance plans that fits their budgets and their needs, and you can’t be turned down because of a pre-existing condition – which before the Affordable Care Act law, you could. The Health Insurance Marketplace is not for those who already have or who are eligible for Medicare.
Financial help is available to make coverage more affordable. About 8 out of 10 people who are eligible for Marketplace coverage qualify for financial assistance to lower the cost of their monthly premiums. And, for many consumers premium increases from last year will be offset because they receive tax credits to make their coverage more affordable.
If you are already enrolled in a Marketplace plan and your plan is still going to be available in 2016, and you want to keep it then you do not have to do anything. However, it pays to shop. You might find a plan that saves you money or has better coverage or both. Last year, those who switched plans within the same level of coverage from the year before, saved an average of nearly $400 on their annual premiums after tax credits.
It is important too that consumers who already enrolled and who are receiving the Advanced Premium Tax Credits, (help with monthly premiums) or the Cost Sharing Reductions, (help with other out of pocket costs) update their applications with their current household income and household size, from last year so that they do not run the risk of losing this help or having to pay back some of the assistance when they file their income taxes next year.
The Affordable Care Act law says that individuals of all ages, including children, have to have minimum essential health coverage, or qualify for an exemption from it, such as making too little to file income taxes, or pay a penalty when filing his or her federal income tax return, as those without health insurance cause insurance premiums to rise, for those who do have health insurance, when the uninsured utilize the health care system.
Coming up in 2016, the penalty for not having health insurance will be 2.5% of your income or $695 per person, whichever is higher and the bottom line is you still won’t have peace of mind coverage if and when you need health care if you don’t enroll in health insurance.
The Affordable Care Act makes quality health insurance available to millions of people who were previously locked out or priced out of the health insurance market.
Free, confidential expert help is available.